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Information Sharing
Topic Collection
October 3, 2024

Topic Collection: Information Sharing

The timely and effective sharing of information within and across jurisdictions, disciplines, and organizations is critical to an effective public health emergency and disaster response. Much progress has been made since 9/11, and best practices indicate that those communities with solid, daily, consistent public health and homeland security collaborations respond better to critical incidents. These resources highlight guidance and lessons learned on information sharing that can help emergency health planners identify stakeholders to incorporate into the information flow, develop rules and elements for sharing, and exchange information to ensure a common operating picture. This Topic Collection concentrates on the information shared, and not on the actual “hardware” or physical elements of the information sharing systems.

Planners may also wish to access several other related ASPR TRACIE Topic Collections for more information. The Communications Systems Topic Collection emphasizes the physical aspects of communications systems including promising practices, reports, evaluations, and overviews of programs focused on creating and maintaining resilient emergency communication systems. The Cybersecurity Topic Collection can help stakeholders better protect against, mitigate, respond to, and recover from cyber threats, ensuring patient safety and operational continuity. Emergency Public Information and Warning/Risk Communications includes lessons learned; education and training modules; results from studies conducted on the effectiveness of risk communications; and plans, tools, and templates that can be tailored to meet the specific threats and needs of healthcare and medical professionals.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Must Reads

Administration for Strategic Preparedness and Response. (2016). Health Care Preparedness and Response Capabilities for Health Care Coalitions. U.S. Department of Health and Human Services.
The guidance specific to these capabilities highlights what healthcare delivery system (e.g., hospitals, healthcare coalitions, and emergency medical services) have to do to effectively prepare for and respond to emergencies that impact the public’s health. Objective 2 (Information Sharing) under Capability 2 (Health Care and Medical Response Coordination) includes three activities and related guidance: develop information sharing procedures; identify information access and data protection procedures; and utilize communications systems and platforms.
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Administration for Strategic Preparedness and Response. (2024). GeoHEALTH. U.S. Department of Health and Human Services.
GeoHEALTH is ASPR's secure Geographic Information System (GIS) based, electronic, interactive mapping application. This application incorporates information from other federal and public agencies (e.g., NOAA, USGS and NGOs) into a single visual environment for enhanced situational awareness, assessment, and management of resources for planning, response to natural, man-made or pandemic events. This system supports functions such as policy analysis, planning, course of action comparison, incident management, and training.
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Centers for Disease Control and Prevention. (2022). Health Alert Network.
The Centers for Disease Control and Prevention use this network to share cleared information about pressing public health incidents with public health professionals.
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U.S. Department of Homeland Security. (2022). Homeland Security Information Network.
This network, referred to as “HSIN,” allows federal, state, local, territorial, tribal, international, and public sector partners in emergency services, intelligence, law enforcement, and other fields to share Sensitive but Unclassified information through an invitational password-protected system.
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Essential Elements of Information

Center for Data Insights and Innovation. (2024). Emergency Information Sharing. State of California .
This webpage includes a link to a table that illustrates the type of health information that can be shared or disclosed during an emergency according to the California Office of Health Information Integrity during an emergency. It also includes links to federal information sharing guidance from the U.S. Department of Health and Human Services Office for Civil Rights, and substance use confidentiality regulations from the Substance Abuse and Mental Health Services Administration.
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Hick, J., Toner, E., Hanfling, D., et al. (2024). Data and Disasters: Essential Information Needed for All Healthcare Threats. (Abstract only.) Health Security. 22(1).
The authors emphasize the need for the healthcare field to use the same essential information systems to ensure patient load balancing, equitable supply allocation, and ultimately, effective and safe patient care.
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Substance Abuse and Mental Health Services Administration. (2023). Substance Use Confidentiality Regulations.
This webpage provides information on the exchange of healthcare records regarding substance use and the confidentiality of these records. It includes relevant links and answers to seventeen frequently asked questions.
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U.S. Department of Health and Human Services. (2022). Is the HIPAA Privacy Rule Suspended During a National or Public Health Emergency?
While the HIPAA privacy rule is not suspended during public health emergencies (PHE), Secretary of Health and Human Services can waive certain provisions of it (e.g., in the emergency area and for the emergency period identified in the public health emergency declaration).This webpage explains under what circumstances these provisions can be waived when the President declares a disaster and the Secretary declares a PHE.
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U.S. Department of Health and Human Services, Office for Civil Rights. (n.d.). Emergency Situations: Preparedness, Planning, and Response.
This website covers HIPAA privacy rules during emergency planning and response, including waivers. The website also provides links to waivers issued for other declared disasters.
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* U.S. Department of Homeland Security. (n.d.). Draft Guidelines for Publishing and Sharing Information. (Accessed 10/3/2024.)
This report—while slightly dated—highlights Capstone 2014, an exercise conducted to develop, codify, and share a set of Essential Elements of Information (EEI; Table 1). Guidance for sharing information through various means (e.g., incident management information systems, geospatial tools) is also included.
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Guidance

Administration for Strategic Preparedness and Response. (2016). Health Care Preparedness and Response Capabilities for Health Care Coalitions. U.S. Department of Health and Human Services.
These four capabilities (Foundation for Health Care and Medical Readiness; Health Care and Medical Response Coordination; Continuity of Health Care Service Delivery; and Medical Surge) can help the healthcare delivery system, including healthcare coalitions, hospitals, and emergency medical services, better understand their roles in preparing for and responding to emergencies that impact the public’s health.
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* AHA Center for Health Innovation. (2022). The CLEAR Field Guide for Emergency Preparedness.
This field guide encourages emergency management stakeholders to break down silos in the emergency management system by incorporating public health officials, local health departments, hospitals and health systems, fire and emergency medical services, and emergency management leaders into emergency preparedness. The guide lists action strategies, resources, and field examples in four priority areas: e.g., strengthening cross-sector partnerships; building workforce capacity and resilience; sharing information; and normalizing a culture of preparedness.
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American Hospital Association. (2019). Sharing Data, Saving Lives: The Hospital Agenda for Interoperability.
This joint statement from several healthcare associations emphasizes the importance and benefits of healthcare data interoperability (e.g., improved care coordination, enabling patients to make more informed decisions, reduced costs in patient/provider time and other resources). The report reviews the potential of interoperability, the establishment of which would also facilitate patient care in a disaster.
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* Connecticut Office of Policy and Management. (2020). Legal Issues in Interagency Data Sharing.
This document details Connecticut’s policy on interagency information sharing. This state-specific example can inform other states’ policies on how to communicate data (including public and mental health data) across agencies in state government in flexible and durable ways.
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FCC Operations and Emergency Management Division. (n.d.). Disaster Information Reporting System (DIRS). (Accessed 10/3/2024.) Federal Communications Commission.
The Disaster Information Reporting System is a voluntary, web-based system that allows communication providers to update their status before, during, and after an emergency. DIRS is for communication providers but may be useful for health care organizations partnering with these communications organizations. Access the updated user guide here: https://www.fcc.gov/sites/default/files/DIRS-UserGuide-122023.docx
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* Federal Bureau of Investigation. (2018). Joint Criminal and Epidemiological Investigations Handbook.
The authors highlight common concerns shared by law enforcement and public health: early identification of an outbreak, whether outbreak is naturally occurring or intentional, and protection of the public. The handbook highlights components of both fields and how they interact and complement each other; discusses investigational procedures and methodologies for a response to a biological threat; identifies challenges and solutions for improved information sharing (p. 55-60); and provides templates that can be replicated or customized.
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Federal Communications Commission. (2024). Operations & Emergency Management Division, Public Safety & Homeland Security Bureau.
This division of the FCC responds to emergencies, prepares for threats, and coordinates communications for public safety and national security. This webpage provides information on the division and provides leadership information.
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Jackson, B. (2006). Information Sharing and Emergency Responder Safety Management.
In this slightly dated, yet useful testimony to the United States House of Representatives, the author shared findings from a study conducted on disaster responder information sharing needs. The four requirements he listed were: information about the hazard environment; information on the responder workforce; information on evolving safety issues; and information about safety equipment. Related recommendations are included.
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Knieser, L. (2022). How to Coordinate Care When Disaster Strikes: The Role of IT. Health Data Management.
This article highlights how healthcare organizations can use technology to facilitate three primary goals during disasters: to locate missing persons, to fill clinical information gaps, and to ensure providers can access real-time admission, discharge, and transfer alerts.
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Patel, D. and Olson, S. (2012). Information Sharing and Collaboration: Applications to Integrated Biosurveillance: Workshop Summary.
The goals of this workshop were: examine strengths and limitations of different models; identify best practices of information sharing; learn more about examples and lessons learn; explore various policy and performance measures; and share real-life scenarios that highlight the value of collaboration and information sharing. Chapter 2 includes examples shared by federal agencies and Chapter 3 highlights state experiences and tools.
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Spector-Bagdady, K., Armoundas, A., Arnaout, R., et al. (2023). Principles for Health Information Collection, Sharing, and Use: A Policy Statement from the American Heart Association. Circulation. 148(13).
The authors describe how the legal use of patient data and information sharing can help bolster healthcare research, develop and test innovative methods, and promote inclusion of marginalized communities in evaluation. The authors list the six principles for health information, collection, sharing, and use to help readers understand how related laws can facilitate information sharing.
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U.S. Department of Homeland Security. (2020). Critical Infrastructure Threat Information Sharing Framework: A Reference Guide for the Critical Infrastructure Community.
This reference describes the systems, access, and policies around sharing threat information between critical infrastructure and public safety. It also includes information on the various tools stakeholders can use to share different types of threat information.
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* U.S. Department of Justice’s Global Justice Information Sharing Initiative. (2011). Health Security: Public Health and Medical Integration for Fusion Centers (An Appendix to the Baseline Capabilities for State and Major Urban Area Fusion Centers).
This guidance document encourages the integration of public health and medical providers into fusion center activity. Guidance is provided by fusion center capabilities and by management and administrative capabilities.
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Information Sharing Systems

Abdolahzadeh, F., Bagherian, H., Peyravi, M., et al. (2023). A Comparative Study of Interagency Communications and Information Exchange in Disaster Response Among Selected Countries. Journal of Education and Health Promotion. 12:251.
The authors compared disaster interagency communications systems in six different countries and found notable differences in the types of data exchanged in each country. Landline and mobile telephones, radio communications, and couriers remain the most common tools used for exchanging information; the authors suggest future research examine information sharing between others, such as healthcare and first responders.
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* Centers for Disease Control and Prevention. (n.d.). National Electronic Disease Surveillance System (NEDSS) Base System (NBS). (Accessed 10/3/2024.)
This information system helps local, state, and territorial public health departments manage reportable disease data and send notifiable disease data to CDC. This tool can support the public health investigation workflow and can also process, analyze, and share disease-related health information. Reporting jurisdictions receive a compatible information system they can use to transfer epidemiologic, laboratory, and clinical data securely and efficiently over the Internet.
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Centers for Disease Control and Prevention. (n.d.). National Syndromic Surveillance Program (NSSP). (Accessed 10/3/2024.)
This platform allows health officials to quickly share and analyze syndromic data over time and across geographic boundaries. It features standardized tools and procedures that facilitate information collection, sharing, evaluation, and storage.
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Centers for Disease Control and Prevention. (n.d.). Office of Public Health Data, Surveillance, and Technology. (Accessed 10/3/2024.)
This website contains links to disease surveillance programs, information systems, and other related resources. Links to recent messages are included on this website as is a legend that explains types of messages disseminated by the system (alerts, advisories, updates, and general information).
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* Centers for Disease Control and Prevention. (2018). Epi-X.
Health professionals can use Epi-X to share preliminary health surveillance information rapidly and securely. Subscribers can also choose to be notified of breaking health news as events occur.
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Centers for Disease Control and Prevention. (2022). Health Alert Network.
The Centers for Disease Control and Prevention use this network to share cleared information about pressing public health incidents with public health professionals.
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* Centers for Disease Control and Prevention. (2023). FluView.
The CDC FluView interactive report provides weekly influenza surveillance information in the United States. These applications were developed to enhance the weekly FluView report by better facilitating communication about influenza with the public health community, clinicians, scientists, and the general public. This series of dynamic visualizations allow any Internet user to access influenza information collected by CDC’s monitoring systems.
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Centers for Disease Control and Prevention. (2024). Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE).
This website describes ESSENCE, a system that allows users to monitor certain worldwide Department of Defense outpatient healthcare data and provides alerts for unusual or rapid increases in the incidence of outbreaks and infectious diseases.
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Centers for Disease Control and Prevention. (2024). National Notifiable Diseases Surveillance System.
This system is used nationwide and allows public health agencies to share notifiable disease-related health information (and monitor, control, and prevent the occurrence and spread of state-reportable and nationally notifiable infectious and noninfectious diseases and conditions).
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Cybersecurity & Infrastructure Security Agency. (n.d.). Emergency Communications Preparedness Center (ECPC). (Accessed 10/3/2024.)
The ECPC is the “federal interagency focal point for interoperable communications coordination.” It is comprised of fourteen federal member departments and agencies who are responsible for or support disaster communications. This webpage includes information on ECPC’s background; the executive and steering committees, subgroups and organizational structure; administrator contact information; and an email for membership inquiries.
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Cybersecurity & Infrastructure Security Agency. (n.d.). Information Sharing: A Vital Resource. (Accessed 10/3/2024.)
This webpage describes the importance of rapid and effective information sharing for all kinds of organizations to promote cybersecurity. It outlines the role and goals of voluntary participation in the Information Sharing and Analysis Organizations established in a 2015 executive order.
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* Lee, C., Kimball, M., Deussing, E., et al. (2023). Use of Information Technology Systems for Regional Health Care Information-Sharing and Coordination During Large-Scale Medical Surge Events. Disaster Medicine and Public Health Preparedness. 18(e1): 1-7.
After a brief description of information technology systems used by emergency management and healthcare, the authors discuss how information sharing improved during the COVID-19 pandemic. They explain how IT systems are used in emergency management and healthcare and how collaborative use identified initial challenges (e.g., with integration and real-time data) and overall helped to improve patient tracking, resource sharing, and operations during patient surges.
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Myers, N. (2021). Information Sharing and Community Resilience: Toward a Whole Community Approach to Surveillance and Combatting the “Infodemic". World Medical & Health Policy. 13(3):581-592.
The authors reviewed the literature to understand how strong information sharing systems can foster effective emergency preparedness and response. They found that involving the public in the information sharing process could increase individual preparedness, strengthen healthcare surveillance, and help decrease the spread of misinformation.
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Office of the Director of National Intelligence. (n.d.). National Counterterrorism Center. (Accessed 10/3/2024.)
The National Counterterrorism Center (NCTC) is staffed by personnel from multiple departments and agencies, including the U.S. Department of Health and Human Services. The Center produces items for the President’s Daily Brief and the daily National Terrorism Bulletin, helps coordinate interagency collaboration, and disseminates a weekly update to senior policymakers regarding threats to the nation. NCTC also serves as the shared knowledge bank on known and suspected terrorists and international terror groups.
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Sauer, L., Resnick, B., Links, J., et al. (2023). Information Challenges Associated with Accessing and Sharing of Patient Information in Disasters: A Qualitative Analysis. Health Security. 21(6).
The authors interviewed 21 physicians who noted three themes of information management challenges during disasters: lack of formal communications during patient handoffs, lack of access to patient medical history, and a dearth of system/population-level data. The authors note these challenges often fall on already overburdened healthcare staff, so novel integrated and systematic approaches are needed to improve real-time information sharing.
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U.S. Department of Homeland Security. (2022). Homeland Security Information Network.
This network, referred to as “HSIN,” allows federal, state, local, territorial, tribal, international, and public sector partners in emergency services, intelligence, law enforcement, and other fields to share Sensitive but Unclassified information through an invitational password-protected system.
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U.S. Department of Homeland Security. (2024). National Terrorism Advisory System.
This system disseminates two types of advisories: bulletins (general information on threats of terrorism) and alerts (specific, credible information about a terrorist threat).
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* U.S. Department of Justice’s Global Justice Information Sharing Initiative. (2011). Health Security: Public Health and Medical Integration for Fusion Centers (An Appendix to the Baseline Capabilities for State and Major Urban Area Fusion Centers).
This guidance document encourages the integration of public health and medical providers into fusion center activity. Guidance is provided by fusion center capabilities and by management and administrative capabilities.
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Lessons Learned

Bennett, K., Olsen, J., Harris, S., et al. (2013). The Perfect Storm of Information: Combining Traditional and Non-Traditional Data Sources for Public Health Situational Awareness During Hurricane Response. PLOS Currents Disasters. Dec 16. Edition 1.
The authors examined whether and how non-traditional data (e.g., tweets and media reports) filled a void in traditional data reporting during the response to Hurricane Isaac in 2012. They also studied the effect of non-traditional data on the timeliness for reporting identified Essential Elements of Information.
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Bharosa, N., Lee, J., and Janssen, M. (2010). Challenges and Obstacles in Sharing and Coordinating Information during Multi-agency Disaster Response: Propositions from Field Exercises. Information Systems Frontiers. 12(1): 49-65.
This paper provides an overview of the relevant obstacles and challenges in regards to sharing and coordinating information by examining existing literature and then investigating a series of multi-agency disaster management exercises, using observations and a survey.
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Booth, C. and Stewart, T. (2003). Communication in the Toronto Critical Care Community: Important Lessons Learned During SARS. Critical Care. 7(6): 405–406.
The authors describe information sharing during the critical care response to SARS. Some of the initiatives that helped the healthcare community exchange information include regular teleconference calls, web-based training and education, and the rapid coordination of research studies.
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Greene, J. (2014). EMS and Information Sharing. Annals of Emergency Medicine 64(2): 15A-17A.
The author describes the challenges and related innovations in information sharing between emergency medical services professionals and the emergency medical care community. Though this emphasizes daily patient care it has direct applicability to the disaster setting and offers significant discussion of issues.
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Harvard Humanitarian Initiative. (2011). Disaster Relief 2.0: The Future of Information Sharing in Humanitarian Emergencies.
This report highlights how social media was used by survivors of the 2010 earthquake that struck Haiti and how it was analyzed internationally to mobilize assistance and map damage. The authors note that “the international humanitarian system was not tooled to handle these two new information fire hoses” and discusses strategies for adapting to this type of information sharing to improve disaster response.
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Howland, R., Li, W., Madsen, A. et al. (2015). Evaluating the Use of an Electronic Death Registration System for Mortality Surveillance During and After Hurricane Sandy: New York City, 2012. American Journal of Public Health 101(11): e55-e62.
The authors evaluated NYC’s electronic death registration system for mortality surveillance during and after Hurricane Sandy, demonstrating how daily data systems can contribute significantly to impact assessment during disasters.
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Institute of Medicine of the National Academies. (2014). Regional Disaster Response Coordination to Support Health Outcomes: Information Sharing and Incident Management— Workshop in Brief.
Workshop participants noted several essential elements of disaster information sharing: reliable systems that can be used by all involved during an incident; improved coordination between agencies and entities that would lead to better public messaging; the use of Scientific Response Units, which would provide an avenue for experts to contribute their knowledge to specific types of incidents; and identifying and using the right “amplifiers” for messages. Case studies from recent events are included.
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Institute of Medicine of the National Academies. (2015). Regional Disaster Response Coordination to Support Health Outcomes: Community Engagement and Information Sharing — Workshop in Brief.
Workshop participants noted several essential elements of disaster information sharing, including: patient tracking and evacuation; hospital surge with those not acutely ill; and coordination of the expansion of focused task forces, organizations, and coalitions involved in disaster response. Case studies from recent events are included.
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* Liu, W., Xu, W., and John, B. (2021). Organizational Disaster Communication Ecology: Examining Interagency Coordination on Social Media During the Onset of the COVID-19 Pandemic. American Behavioral Scientist. 65(7):914-933.
The authors examined how several Texas public health departments communicated with one another during the COVID-19 pandemic, including how similar terminology facilitated coordination among multiple jurisdictions, and how retweeting facilitated dissemination of information about COVID-19. The authors conclude with practical takeaways for local health departments and healthcare communications in disaster management.
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Loschen, W., Holtry, R., Hazins, K., and Happel Lewis, S. (2013). Sharing Public Health Information with Non-Public Health Partners. Online Journal of Public Health Informatics. 5(1): e47.
The authors provide an overview of ESSENCE and describe how healthcare stakeholders from across the National Capital Region in Maryland, Virginia, and the District of Columbia worked together to develop it. This information sharing tool is currently used by public health and non-public health partners (e.g., emergency management, law enforcement, and other first responders).
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Region IV Public Health Training Center Network. (2015). The PHTC Network's Collective Role in Helping the Public Health Workforce Prepare for and Respond to Infectious Diseases: What We've Learned from Ebola.
This webinar is approximately 1.5 hours long and includes presentations on: the practice and roles of health departments in preventing and controlling infectious diseases; public health information sharing during a public health event; priority knowledge, skills, and abilities (KSAs) needed by the public health workforce to prepare for and respond to infectious diseases; and additional information from national partners.
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Sane, J. and Edelstein, M. (2015). Overcoming Barriers to Data Sharing in Public Health: A Global Perspective.
The authors report findings from interviews with high-level decision-makers, field epidemiologists, academics and individuals responsible for disease surveillance at the national level, in both high income and low-middle income countries. Participants described how data sharing is part of their usual work; they also shared input on barriers to data sharing they have encountered or are aware of and how they overcame them (during routine surveillance and public health emergencies).
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Tsai, S., Hamby, T., Chu, A., et al. (2016). Development and Application of Syndromic Surveillance for Severe Weather Events Following Hurricane Sandy. (Abstract only.) Disaster Medicine and Public Health Preparedness. 10(3): 463-471.
After Superstorm Sandy, the New Jersey Department of Health developed indicators to improve syndromic surveillance for extreme weather events in EpiCenter, an online system that allows users to collect and analyze real-time chief complaint emergency department data and classifies each visit by indicator or syndrome. This system was able to recognize indicators in carbon monoxide poisoning, methadone-related visits, and asthma. Recognizing sources of data and the indicators to be followed are important during planning and response.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). ASPR Electronic Medical Record (EMR) Data Share with FL Department of Health. (Contact fusion@hhs.gov for more information or to set up EMR data sharing capabilities.)
ASPR provided a de-identified data share of electronic medical record (EMR) data for patient encounters in the field to Florida Department of Health (FL DOH) from Disaster Medical Assistance Team (DMAT) teams deployed after Hurricane Matthew to provide medical support at Holmes Regional Medical Center in Melbourne, FL. ASPR was able to provide an automated EMR data share (updated every 15 minutes) directly to FL DOH's surveillance system ESSENCE-FL resulting in robust state/federal data sharing.
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* U.S. Department of Homeland Security. (n.d.). Draft Guidelines for Publishing and Sharing Information. (Accessed 10/3/2024.)
This report—while slightly dated—highlights Capstone 2014, an exercise conducted to develop, codify, and share a set of Essential Elements of Information (EEI; Table 1). Guidance for sharing information through various means (e.g., incident management information systems, geospatial tools) is also included.
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Van Panuis, W., Paul, P., Emerson, C., et al. (2014). A Systematic Review of Barriers to Data Sharing in Public Health. BMC Public Health. 14:1144.
This systematic literature review found 20 potential barriers to public health data sharing classified by the authors as technical, motivational, economic, political, legal and ethical. The authors stress the need to understand the interactions between these barriers and tailor specific data sharing strategies to different types of data.
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Lessons Learned: COVID-19

Holmgren, A., Apathy, N., and Adler-Milstein, J. (2020). Barriers to Hospital Electronic Public Health Reporting and Implications for the COVID-19 Pandemic. Journal of the American Medical Informatics Association. 27(8): 1306-1309.
Based on 2018 American Hospital Association annual survey data, the authors determined that the most common barrier to hospital reporting of electronic surveillance data during the COVID-19 pandemic was the inability of public health agencies to electronically receive the data. They encourage policymakers to make public health IT infrastructure investment a priority for current and future pandemic preparedness.
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* Lee, C., Kimball, M., Deussing, E., et al. (2023). Use of Information Technology Systems for Regional Health Care Information-Sharing and Coordination During Large-Scale Medical Surge Events. Disaster Medicine and Public Health Preparedness. 18(e1): 1-7.
After a brief description of information technology systems used by emergency management and healthcare, the authors discuss how information sharing improved during the COVID-19 pandemic. They explain how IT systems are used in emergency management and healthcare and how collaborative use identified initial challenges (e.g., with integration and real-time data) and overall helped to improve patient tracking, resource sharing, and operations during patient surges.
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Lipsitch, M., Bassett, M., Brownstein, J., et al. (2024). Infectious Disease Surveillance Needs for the United States: Lessons from Covid-19. Frontiers in Public Health. 12.
The authors note the challenges associated with surveillance during the COVID-19 pandemic and list the nature of, data needed for, and strategies that can help healthcare and other community leaders make decisions based on disease surveillance.
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* Liu, W., Xu, W., and John, B. (2021). Organizational Disaster Communication Ecology: Examining Interagency Coordination on Social Media During the Onset of the COVID-19 Pandemic. American Behavioral Scientist. 65(7):914-933.
The authors examined how several Texas public health departments communicated with one another during the COVID-19 pandemic, including how similar terminology facilitated coordination among multiple jurisdictions, and how retweeting facilitated dissemination of information about COVID-19. The authors conclude with practical takeaways for local health departments and healthcare communications in disaster management.
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National Healthcare Safety Network. (2023). Transition of COVID-19 Hospital Reporting. Centers for Disease Control and Prevention.
This report details the type of essential COVID-19 data hospitals were asked to voluntarily share during the pandemic (e.g., capacity, supplies, influenza-specific, therapeutics, and staff vaccination). It includes tables that list sample reporting cadences, information on how to report, and data elements requested.
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O’Connell, M. and Abourezk, C. (2023). Facilitating the Urgent Public Health Need to Improve Data Sharing with Tribal Epidemiology Centers. (Abstract only.) Public Health Reports. 138(2 suppl): 80S-83S.
The authors provide an overview of the history and significance of Tribal Epidemiology Centers (TECs) and related federal statutes that allow TECs to access and use protected health information for public health purposes. They note challenges with accessing data during the COVID-19 pandemic and encourage more compliance with federal data sharing laws to safeguard the health of tribal communities.
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Rigby, R., Ferdinand, A., Kum, H., and Schmit, C. (2024). Data Sharing in a Decentralized Public Health System: Lessons From COVID-19 Syndromic Surveillance. JMIR Public Health and Surveillance.
The authors highlight the data sharing challenges experienced by syndromic surveillance partners during the COVID-19 pandemic and emphasize the need for decentralization and collaboration when it comes to data sharing.
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Plain Language and Emergency Codes

Iowa Hospital Association. (2020). Plain Language Emergency Codes Implementation Guide.
This document describes the rationale for updating color codes for emergencies in hospitals to plain language alerts. Plain language is preferable because color codes previously differed by health care system, feedback indicated color codes caused stress, and the Joint Commission supported adoption of more transparent language for alerts.
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New Jersey Hospital Association. (n.d.). Plain Language Emergency Alert. (Accessed on 10/3/2024.)
This toolkit was designed to help state emergency management staff transition alerts to plain language. it includes a step-by-step implementation guide; a poster to inform staff, patients and guests of the new alert system; a PowerPoint presentation; and a 2-minute education video.
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Prickett, K.J. and Bellino, J. (n.d.). White Paper. Plain Language Emergency Alert Codes: The Importance of Direct Impact Statements in Hospital Emergency Alerts. (Accessed 10/3/2024.)
This white paper addresses the implementation of plain language emergency alert code systems in healthcare facilities. The authors discuss how this change can benefit healthcare associates, external emergency responders, patients, and visitors by reducing the amount of confusion and anxiety that is associated with traditional code word or color emergency alerting systems.
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Public Health Communications Collaborative. (2023). Plain Language for Public Health.
This guide provides an overview of plain language principles and includes sections on preparing communications, developing and organizing communications, reviewing and testing, and related resources.
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U.S. Department of Homeland Security. (2010). Plain Language Guide Frequently Asked Questions.
While slightly dated, this document clearly lays out the principles and importance of plain language during interagency coordination as part of the National Incident Management System. It explains why plain language is important to safety during emergency and disaster response and how to employ it.
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Plans, Tools, and Templates

Agency for Toxic Substances and Disease Registry. (2020). Comprehensive Disaster Assessment and Readiness Tools (CDART). U.S. Centers for Disease Control and Prevention.
The Agency for Toxic Substances and Disease Registry provides this overview of CDART, a series of app-based surveys to evaluate how ready a public health or healthcare facility is and how it is faring during a disaster. It includes a readiness check, rapid disaster assessment tool, and comprehensive disaster assessment tool. The tools can be adapted for other local, state, or territorial health departments as needed and can display during an incident as ArcGIS layers.
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* AHA Center for Health Innovation. (2022). The CLEAR Field Guide for Emergency Preparedness.
This field guide encourages emergency management stakeholders to break down silos in the emergency management system by incorporating public health officials, local health departments, hospitals and health systems, fire and emergency medical services, and emergency management leaders into emergency preparedness. The guide lists action strategies, resources, and field examples in four priority areas: e.g., strengthening cross-sector partnerships; building workforce capacity and resilience; sharing information; and normalizing a culture of preparedness.
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Association of State and Territorial Health Officials. (2013). Public Health and Information Sharing Toolkit: Legal Barriers Project.
This toolkit (while slightly dated) includes links to resources that focus public health agencies' authority to collect, use, and share information to prepare for and respond to a public health emergency. Resources include “executive overviews,” fact sheets, issue briefs, state analysis guides, and supplemental resources.
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* Centers for Disease Control and Prevention. (n.d.). National Electronic Disease Surveillance System (NEDSS) Base System (NBS). (Accessed 10/3/2024.)
This information system helps local, state, and territorial public health departments manage reportable disease data and send notifiable disease data to CDC. This tool can support the public health investigation workflow and can also process, analyze, and share disease-related health information. Reporting jurisdictions receive a compatible information system they can use to transfer epidemiologic, laboratory, and clinical data securely and efficiently over the Internet.
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Centers for Disease Control and Prevention. (n.d.). PHIN Tools and Resources. (Accessed 10/3/2024.)
This site includes links to Public Health Information Network tools and resources; this information can help public health agencies to electronically exchange health data and information.
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* Centers for Disease Control and Prevention. (2018). Epi-X.
Health professionals can use Epi-X to share preliminary health surveillance information rapidly and securely. Subscribers can also choose to be notified of breaking health news as events occur.
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Centers for Disease Control and Prevention. (2021). Minimum Data Set for Public Health Emergency Operations Center.
This Excel file contains the EOC Minimum Data Set (MDS) developed by CDC and LOINC. This is a technical specification for collecting and reporting situational awareness and other operational data for public health emergencies, including COVID-19.
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* Centers for Disease Control and Prevention. (2023). FluView.
The CDC FluView interactive report provides weekly influenza surveillance information in the United States. These applications were developed to enhance the weekly FluView report by better facilitating communication about influenza with the public health community, clinicians, scientists, and the general public. This series of dynamic visualizations allow any Internet user to access influenza information collected by CDC’s monitoring systems.
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* Connecticut Office of Policy and Management. (2020). Legal Issues in Interagency Data Sharing.
This document details Connecticut’s policy on interagency information sharing. This state-specific example can inform other states’ policies on how to communicate data (including public and mental health data) across agencies in state government in flexible and durable ways.
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* Federal Bureau of Investigation. (2018). Joint Criminal and Epidemiological Investigations Handbook.
The authors highlight common concerns shared by law enforcement and public health: early identification of an outbreak, whether outbreak is naturally occurring or intentional, and protection of the public. The handbook highlights components of both fields and how they interact and complement each other; discusses investigational procedures and methodologies for a response to a biological threat; identifies challenges and solutions for improved information sharing (p. 55-60); and provides templates that can be replicated or customized.
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HealthIT.gov. (2021). Public Health Emergency Preparedness and Response. U.S. Department of Health and Human Services.
The ONC ISA provides a standardized vocabulary for exchanging public health situational awareness data, including COVID-19, for categories such as: representing healthcare personnel status, representing hospital/facility beds utilization, representing laboratory operations, and representing population-level morbidity and mortality.
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National Information Exchange Model. (n.d.). National Information Exchange Model (NIEM). (Accessed 10/3/2024.)
NIEM was developed by experts from a variety of fields, agencies, and organizations and serves as a common vocabulary that facilitates efficient information exchange. NIEM includes domains for Emergency Management, Justice, Military Operations, Surface Transportation, Biometrics, and Human Services. NIEM provides rules and methodologies around the use of the model as well as a standardized Information Exchange Development Lifecycle that can be reused by everyone. NIEM also includes governance, training, tools, technical assistance, and an engaged community that can provide user support.
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U.S. Department of Homeland Security. (n.d.). Resources for Emergency Medical Services and Fusion Center Collaboration. (Accessed 10/3/2024.)
This document includes agency summaries and contact information for various federal fusion centers and related organizations.
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U.S. Fire Administration. (2023). About the Emergency Management and Response — Information Sharing and Analysis Center.
This agency serves as an information sharing tool for critical infrastructure protection (CIP) and the emergency services sector (ESS). The agency publishes “The InfoGram” and CIP bulletins and provides technical assistance and consulting at no cost to ESS leaders.
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Agencies and Organizations

Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT. Health Information Exchange.
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Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT. Topics.
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Centers for Disease Control and Prevention. National Electronic Disease Surveillance System (NEDSS) Base System (NBS).
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Centers for Disease Control and Prevention. Health Alert Network.
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Cybersecurity & Infrastructure Security Agency. Emergency Communications Preparedness Center (ECPC).
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Cybersecurity & Infrastructure Security Agency. Emergency Services Sector Information Sharing Initiative.
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Federal Bureau of Investigation. Infraguard.
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Federal Communications Commission. Operations & Emergency Management Division, Public Safety & Homeland Security Bureau.
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National Health ISAC. National Health Information Sharing and Analysis Center.
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Office of the Director of National Intelligence. National Counterterrorism Center.
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U.S. Department of Homeland Security. Information Sharing and Awareness.
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U.S. Department of Homeland Security. State and Major Urban Area Fusion Centers.
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This ASPR TRACIE Topic Collection was comprehensively reviewed in September 2024 by the following subject matter experts (listed in alphabetical order):  

Julie Bulson, DNP, MPA, RN, NE-BC, HcEM-M, Director, Business Assurance, COREWELL HEALTH; Damon A. Darsey, MD, FAEMS, CEO Paladin Emergency Services Consulting, Medical Director Mississippi Department of Public Safety; John Hick, MD, Hennepin Healthcare; LCDR Krista Marquard, PT, DPT, MSDS, United States Public Health Service; Danielle Marten, MPA, CHEP  Co-Owner, Healthcare Coalition Partners of KS, LLC; Capt. Molly Rutledge, M.A., M.S., USPHS Commissioned Corps; Tim Settles, MSEM, CEM, CCMC, CHEP,CHPP, OCEM, MCP, Deputy Director, Ashtabula County Emergency Management Agency; and Tami Wood, BSN, RN, MICT, Co-Owner, Healthcare Coalition Partners of KS, LLC.  

It was reviewed in April 2017 by: Eric Alberts, CEM, CHS-V, FPEM, FPEM-HC, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Manager, Emergency Preparedness, Orlando Health, Inc. (Hospital System); Marc Barbiere, MPH, CEM, Assistant Emergency Management Coordinator, City of Round Rock (TX) Fire Department, Homeland Security and Emergency Management Division; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Jodi Keller, RN, Associate Director of Healthcare System Emergency Preparedness, Central Ohio Trauma System; Diana M. Kushner, MPH, Senior Public Health Analyst, HHS ASPR; Mary Massey, BSN, MA, PHN, California Hospital Association; Michael Melton, MPA, MA, Emergency Logistics Coordinator, Emergency Preparedness and Response Division, Los Angeles County Department of Public Health; Nancy Nurthen MPH, ASPR/OEM Fusion; Ann Potter, RN, CEM, CHEP, Project Specialist, ER-One, Institute for Public Health Emergency Readiness, Medstar Washington Hospital Center; Jeff Rubin, PhD, CEM, Emergency Manager, Tualatin Valley (OR) Fire & Rescue; and Mary Russell, EdD, MSN, Emergency Services, Boca Raton Regional Hospital.

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